8 Questions to Ask When Choosing a Health Plan

Now, more than ever, it’s important to choose a health insurance plan that works for you. Considering the following questions can help you find the plan that meets your needs.

1. Is my doctor in the network?

If you have doctors or specialists you like, check if they’re in your plan’s network. Why? Because your costs are usually lower when you use an in-network doctor. Visit our Find a Doctor page to see if your doctor is in the EmblemHealth network.

2. Is my medicine covered, and how much will it cost?

Health plans have drug lists (also called formularies) of the prescription medicines that they cover. Your benefit summary will show how much you will pay for drugs in different “tiers” on the drug list. Many plans (like EmblemHealth) also have a way for you to price a specific drug and can help you sign up for home delivery. You can find EmblemHealth formularies here to learn more.

3. What type of health coverage is right for me?

Think about what health care services you and each family member might need in the coming year. For example:

• Do you see a doctor regularly for a health condition?
• Do you take expensive or brand-name medications on a regular basis?
• Are you expecting a baby, plan to have a baby, or have small children?
• Do you have a planned surgery coming up?

Then, look over your plan options and estimate your costs based on your needs.

4. What happens if I need care when I’m away from home?

• Check to see if the plan covers emergency services outside of its normal service area.
• See if it offers telemedicine services (most EmblemHealth plans do). Telehealth, or virtual visits, let you use your phone, mobile device or a computer to consult a doctor from almost anywhere you are.
• Find out where you can look up urgent care centers if you’re away from home and suddenly get sick.

5. What is the most I’d have to spend*?

There are two things to look at with many plans:

• What’s the deductible? – That’s the amount you have to pay before the plan begins to pay for covered medical expenses.
• What’s the “maximum out-of-pocket,” or “MOOP” for short? That’s the most you’d have to pay towards your covered medical expenses.

6. What will I pay for services I use often?

The amount you pay for things like a visit to your primary care provider (PCP) or a specialist depends on your specific EmblemHealth plan. Your benefit summary (available by logging in to myEmblemHealth for Members) shows what services require a copayment and if it is applied before or after meeting the plan’s deductible.

7. Does the plan include dental coverage, or can I buy it?

Some may include or offer, at an added charge, dental coverage for preventive services (such as cleanings) and comprehensive services (such as fillings and crowns). Some medical plans, by law, include pediatric (children’s) dental coverage. Ask if you want to know more. 

8. Am I eligible for a health savings account (HSA)?

Check if a plan allows you to save pre-tax money in an HSA. Only some plans do. An HSA helps you save money to cover qualified medical expenses.

Have more questions?

Whether you’re buying insurance on your own or through an employer, we’re here to help you make the right choice. Learn more about our plans or call 866-274-0060. 

*EmblemHealth HMO plans do not have an out of network benefit. If you choose to use an out of network provider with an HMO for non-emergent care, costs may be the full responsibility of the member.